Back
A Proposal for Early Dosing Regimens in Heart Transplant Patients Receiving Thymoglobulin and Calcineurin Inhibition.
Journal article

A Proposal for Early Dosing Regimens in Heart Transplant Patients Receiving Thymoglobulin and Calcineurin Inhibition.

  • Barten MJ University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
  • Schulz U Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
  • Beiras-Fernandez A Department of Cardiac and Thoracic Surgery, Johann-Wolfgang-Goethe University, Frankfurt am Main, Germany.
  • Berchtold-Herz M Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany.
  • Boeken U Department of Cardiovascular Surgery, Heinrich Heine University, Düsseldorf, Germany.
  • Garbade J Department of Cardiac Surgery, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany.
  • Hirt S Department of Cardiac and Thoracic Surgery, University of Regensburg, Regensburg, Germany.
  • Richter M Kerckkoff Clinic, Bad Nauheim, Germany.
  • Ruhpawar A Cardiac Surgery Clinic, University of Heidelberg, Heidelberg, Germany.
  • Schmitto JD Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
  • Schönrath F Department of Cardiac, Thoracic and Vascular Surgery, German Heart Institute, Berlin, Germany.
  • Schramm R Clinic of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany.
  • Schweiger M Department of Cardiac Surgery, Children's Hospital, Zürich, Switzerland.
  • Wilhelm M Clinic for Cardiovascular Surgery, University Hospital Zürich, Zurich, Switzerland.
  • Zuckermann A Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Show more…
  • 2016-08-09
Published in:
  • Transplantation direct. - 2016
English There is currently no consensus regarding the dose or duration of rabbit antithymocyte globulin (rATG) induction in different types of heart transplant patients, or the timing and intensity of initial calcineurin inhibitor (CNI) therapy in rATG-treated individuals. Based on limited data and personal experience, the authors propose an approach to rATG dosing and initial CNI administration. Usually rATG is initiated immediately after exclusion of primary graft failure, although intraoperative initiation may be appropriate in specific cases. A total rATG dose of 4.5 to 7.5 mg/kg is advisable, tailored within that range according to immunologic risk and adjusted according to immune monitoring. Lower doses (eg, 3.0 mg/kg) of rATG can be used in patients at low immunological risk, or 1.5 to 2.5 mg/kg for patients with infection on mechanical circulatory support. The timing of CNI introduction is dictated by renal recovery, varying between day 3 and day 0 after heart transplantation, and the initial target exposure is influenced by immunological risk and presence of infection. Rabbit antithymocyte globulin and CNI dosing should not overlap except in high-risk cases. There is a clear need for more studies to define the optimal dosing regimens for rATG and early CNI exposure according to risk profile in heart transplantation.
Language
  • English
Open access status
gold
Identifiers
Persistent URL
https://sonar.ch/global/documents/299112
Statistics
Document views: 27 File downloads: